Memeorandum

March 31, 2014

Phony ObamaCare Success Statistics

Today is notionally the final day for ObamaCare sign-ups, so the usual suspects in the national media are engaging in some "how're we doin?!?' reporting cheerleading. At the risk of being struck by a pom-pom let me single out the LA Times - their story which has seized the post position at Memeorandum, deserves special mention for this dubious stat:

At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand’s unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law’s implementation.

Sicne their headline included the factoid that "At least 9.5 million previously uninsured people have gotten health insurance since Obamacare started", that 4.5 million from Medicaid is a big deal. But how meaningful is that estimate?

A huge caveat that ought to be attached to that number (but hasn't been) comes from what has become known as the "woodwork effect" - with all the hue and cry about ObamaCare, people who were previously eligible for Medicaid have "come out of the woodwork" to sign up. An ardent ObamaCare booster might insist that they only way we could have ginned up all that publicitity was by crafting and cramming down a complex, unpopular bill; here on the third planet, we will argue that a much less complex PR campaign could have boosted Medicaid enrollment with a lot less controversy.

A new analysis by Avalere Health finds that the Affordable Care Act’s open enrollment season is boosting Medicaid signups even in the states that have refused the health law’s optional Medicaid expansion.

“Enrollment of new Medicaid beneficiaries continues in both expansion and non-expansion states,” said Jenna Stento, senior manager at Avalere Health, in a statement. “Medicaid applications have increased 27 percent on average from October to January compared to application rates before ACA. Application rates in expansion states increased 41 percent over the same period.”

Stento told ThinkProgress that enrollments even in non-expansion states grew by 13 percent from October through January, compared to previous months.

Avalere estimates that between 700,000 and 800,000 Americans in non-expansion states who were already eligible for existing Medicaid programs, but never actually signed up for them, enrolled between October through January. This is a phenomenon that health care experts refer to as the ACA’s “woodwork effect,” wherein eligible populations come “out of the woodwork” amid persistent national and local coverage of the health law’s signup period. Some of these people may simply not have known that they previously qualified for government health care benefits, or didn’t know how to sign up.

Expansion states saw much bigger enrollment hikes, with somewhere between 1.7 million and 2.7 million signing up for Medicaid for the first time, since some people in those places became newly eligible under expansion. All told, between 2.4 million and 3.5 million of the poorest Americans started receiving Medicaid coverage for the first time during the first four months of Obamacare’s enrollment season.

The population split between expansion and non-expansion states seems to be roughly equal (based on learning that the overall average increase of 27% comes from subgroups of 13% and 41%, as well as this map and this list.)

So if we assume 800k 'woodworkers' for the non-expansion state, how many similar people came out of the woodwork in the expansion states? One might argue that, lacking other information, it is plausible to assume that the proportion is the same. So, with total expansion of 3.5 million as of January (the high estimate), we would be estimating 1.6 million 'woodworkers' and 1.9 million people that are newly eligible under the revised and expanded law. The woodworkers represent 46% of the total.

But wait! One might argue that the states that expanded Medicaid have a long, proud history of generosity with other people's money and would have worked hard over the years to sign up as many eligible people as possible. In which case, substantially all of the 'woodworkers' will be found in the non-expansion states; this puts them at 23% of the total at the end of January.

Now, did the composition of Medicaid enrollees change substantially in February and March? Who knows? But lacking final reports, a fair range for the number of newly-insured 'woodworkers' would be 23% to 46% of the 4.5 million figure cited by the LA Times. That would lead to a 1 to 2 million reduction in the new Medicaid enrollment and consequently a 1 to 2 million reduction in the headlined 9.5 million figure.

Comments

she's very sick, maybe dying, so yes it is manifest whatever has been done to date isn't helping her. This is one case where I would welcome a legal gadfly like dershowitz, he will make the legal process work best for her. What is best for her? I have no idea.

Jane,
Regarding your conversation with Amy - I think that she is overlooking the horrible dynamic that can develop when individuals or families are dealing with large & powerful bureaucracies. I have a 16 year old son with autism and so my husband and I have become somewhat expert over the years in dealing with school, medical, & govt. systems. I'm sure most people go into these fields with wonderful intentions and for the most part we have had great or at least benign experiences. We are TRULY are grateful for all the teachers, doctors, behaviorists, etc. that have been so helpful with our son.

However, the few times when conflicts have arisen we have found that the powers that be have had no compunction about coming down like a ton a bricks without compunction or conscience on us as a family and our special needs child ( I think he was 3 or 4 the first time the first time they threatened to suspend him from school while I was spending the days with my mother in the hospital who was dying from cancer). We are not difficult or confrontational as a general rule, but we are very able to stand our ground and know our rights and it has taken a lot of pushback at certain times over the years.

CR it seems to have been human nature from the beginning. Public servants eventually cease being that. If they start running in packs (unions) and can be led for malignant purposes, then you have Robespierre or Nazi Brown Shirts or Black shirted thugs or SWAT teams with no-knock tactics or Police Departments with tanks or Coercive Departments of XYZ, and soon Death Panels.

Amy stays out of politics because she has young kids and doesn't want to spend her life pissed off. She is married to a doctor, and she looks for the good in things. She hasn't convinced me she is correct, I still think there is a terrible wrong here, but she often tugs me back to a little reality.

"Medicaid applications have increased 27 percent on average from October to January compared to application rates before ACA. Application rates in expansion states increased 41 percent over the same period.”

This is a complete lie. You can download the data yourself from the Medicaid site here and compile each month.

The average monthly number of new applications in the period of Oct13-Jan14 was:

2329821/month. The monthly average during July-Sept13 was 2285806/month.

In expanding stats the monthly was 1216529/month Dec-Jan14 vs 1163350 July-sep13. There was perhaps a net increase of 50,000/month over 4 months there. New applications in expanding states DROPPED by 152000 in Jan14 compared to Dec13.

Go ahead. Download the PDF files and compile the numbers in an excel spreadsheet. The claims above are a complete lie.

They also have numbers for applications for aid in the state exchanges (the subsidized plans, not medicaid). They reached a peak of 1268718 in Dec13 and DROPPED BY 50% in Jan13 to 638,126.

I will add one more item, straight from the PDF's on the Medicaid application and eligibility page. Change between the applications in a given month and the monthly average for July-Sept13 for states expanding Medicaid coverage (many expansions did not go into effect until Jan14, BTW) Here they are

Oct13 +11%
Nov13 -7.2%
Dec13 +6.9%
Jan14 -4.9%

Yet the people quoted claim they increased by 41% compared to July-Sep13.

These are their own numbers. A few states, NY being the most populous, did not submit data.